Basic Biomechanics

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<p>I'i,~ic Di~fIDA~~,hani'$()w~</p> <p>THE</p> <p>a</p> <p>'!'</p> <p>i</p> <p>~</p> <p>MA:RGVICTO,lI,,"',-.i,""</p> <p>'.</p> <p>BASIC BIOMECHANICSof the</p> <p>MUSCULOSKELETAL SYSTEMMargareta Nordin, P.T., Dr. Sci.Director. Occupational and Industrial Orthopaedic Center (OIOC)</p> <p>Hospital fOf Joint Diseases Orthopaedic InstituteMt. Sinai NYU Health</p> <p>Program of Ergonomics and Biomechanics, New York University Research ProfessorDepartment of Orthopaedi" and Environmental Heallh Science</p> <p>School of Medicine. New York UniversityNew York. New York</p> <p>Victor H. Frankel, M.D., Ph.D., KNOPresident EmeritusHospital for Joint Diseases OrthopaedIC Institute</p> <p>Professor of Orthopaedic Surgery New York University School of MedicineNew York, New YorkDawn Leger, Ph.D., Developmental Editor Kajsa Forssen, Illustrator Angela Lis, P.T., M.A.. Editorial Assistant</p> <p>$~~ LipPINCOIT WILLIAMS &amp; WILKINS A wohl'r! Klllwtr (ornp.lny</p> <p>l'hil.ldclphi'l B"llimore New"ork . london [lucllOS Ailes' Hong Kong Sydney T{lkyo/</p> <p>..._-4&gt;</p> <p>1</p> <p>foreword</p> <p>Mechanics and biology have always fascinated humankind, The irnportance or understanding the biomechanics of the musculoskeletal system cannot be underestimated, Much a([entian has been paid in recent years to genetic and biomoleClilar research, but the stlld~' of the mechanics of structure and of the whole body s}'stcm is still of immense importance. Musculoskeletal ailments arc among the most prevalent disorders in the wodd and will continue to grow as the population ages. Since the days when I first studied biomechanics in Sweden with Carl Hirsch, through my years as an orthopaedic surgeon, teacher, and researcher, I have alway's emphasized combining basic and applied research with clinical experiencc, This text represents my fifth effort to integrate biomechanical knowledge into clinical training for patient carc. It is not a simple task but by relating the basic concepts of biomechanics to everyday life, rehabilitation. orthopaedics. traumatology, and patient care are greatly enhanced. Biomechanics is a multidisciplinary specialty, and so we have made a special effort to invite contributors from many disciplines so that individuals from dilTerent fields may feel comFortable reading this book. Together with an invaluable team, Margareta Nordin and I have produced Ihis third edition of Basic Biol1lechanics oFthe A'lusclt!o.\'keletal Systelll, The new edition is shall1cncc! and improved thanks to the input from the students and resi</p> <p>dents in orthopaedics Ihal during the past 10 years have llsed the texl. This book is written for students and with a major input from students and will hopefully be used to edunHe students and residents for many ~Iears to come. Although the basic information contained in the book remains largely unchanged, a considerable amount of extra information has been provided throughoul. ~Ve have also made a special point to document with the key references any significant changes in the field of biomechanics and rehabilitation. It has always been m)' interest lO bridge the gap between engineering knowledge and clinical carc and praclice, This book is written primarily for clinicians such as orthopaedists, physical and occupational therapists, clinical ergonomisls, chiropractors, and olher health professionals who arc acquil-ing a working knowledge of biomechanical principles for use in the evaluation and treatment of musculoskeletal dysfunction. We only hope that if you find this book int~resting. you will seek more in-depth study in the field of biomechanics. Enjo\' it. discuss it, and become a beller clinician and/or researchcl: Vve are extremely proud that Basic BiomeclUluics oj" the !\tlllscliioskeic/lli Sysle111 has been designated "A Classic" by the publishers, Lippincott Williams &amp; Wilkins. We Ihank the readers, students, professors, and all who acquire thc tcxt and lise it.VielO,. H. Frallkel, M.D., Ph.D., KNO</p> <p>vii</p> <p>.,</p> <p>Preface</p> <p>Biomechanics uses physics and engineering concepts to describe the motion undergone by the various body segments and forces acting on these body parts during normal activities. The inter-relationship of force and motion is important and must be understood if rational treatment programs are to be applied to musculoskeletal disorders. Deleterious effects may be produced if the forces acting on the areas with disorders rise 10 high levels during exercise or other activities of daily living. The purpose of this text is to acquaint the readers with the force-motion relationship \vithin the musculoskeletal system and the various tech~ niqucs llsed to understand these relationships. The third edition of Basic Biol1/eclwllics of rite iHllScliloskeleral System is intended for use as a textbook either in conjunction with an introductory biomechanics course or for independent study. The third edition has been changed in many ways, but it is still a book that is designed for use by students who are interested in and want to learn about biomechanics. It is primarily written for students who do not have an engineering background but who want to understand the most basic concepts in biomechanics and physics and how these apply to the human body Input from students has greatly improved this third edition. We have used the book for 10 years in the Program of Ergonomics and Biomechanics at New York University', and it is the students and residents who have suggested the changes and who have continuously shown an interest in developing and irnproving this book. This edition has been further strengthened by the contribution or the students over the past year. \Vc formed focus groups to understand better what thc students wanted and applied their suggestions wher-</p> <p>ever possible. We retained the selected examples to illustrate lhe concepts needed for basic knowledge of the musculoskeletal biomechanics; we also have kept the important engineering concepts throughout the volume. We have added four chapters on applied biomechanics topics. Patient case studies ancl calculation bo:'\cs have been added to each chapter. \Ne incorporated flowcharts throughout the book as teaching tools. The text will serve as guide to a deeper understanding of musculoskeletal biomcchanics gained through funher reading and independent research. The information presented should also guide the rt.'ader in assessing the literature on biomechanics. "Vc have attemptcd to provide therapcutic examples but it was not our purpose to cover this area; instead, \ve have described the undel'lying basis for rational therapcutic or exercise programs. An introductory chapter describes the inlporlance of the study of biomechanics, and an appendix on the international system of measurements serves as an introduction to the physical measurements used throughout the book. The reader needs no more (han basic knowledge of mathematics to fully comprehend the material in the book, but it is important to review the appendix on the Sl System and its application to biomechanics. The body of the third edition is then divided into three sections. The first section is the Biomechanics of Tissues and Stnlcturcs of the Musculoskeletal System and covers the basic biomechanics of bone, ligaments, cartilage. tendons, muscles, and nenres. The second section covers the Biomechanics-of Joints, including every joint system in the human body. Chapters range from the foot and ankle through the cervical spine, and co\'er eve I:" joint in between. The third sec-</p> <p>e .-..</p> <p>---~-_.--</p> <p>. _--.-._.. _------- .-.- . ----.. -.-....</p> <p>-'------------~---</p> <p>..</p> <p>,~".--</p> <p>. . -.. ..- ...-.--..-------..~.~ ~</p> <p>-.,,"------~-----</p> <p>-",,--.-.---.------</p> <p>Ox</p> <p>.PREfACE</p> <p>tion cover~ some topics in Applied Biomechanics, including chapters on fracture fixation; arthroplasty; silting, standing and lying; and gait. These arc basic chapters that sl:l\r e to intra c1uce topics in applied biomechanics: they arc not in-depth explorations of the subject. Finally. we hope that the revision and expansion of this third edition of" Basic 13io11leclulJIics</p> <p>oFthe kluscu/oskelela/ Syslel1l will bring about an increased awareness of the imparlance of biomechanics. II has never been our intention to complL'tely cover the subject, but instead provide a basic introduction to the field that will lead to further study or this important lopic.Margarela NOf(!;11 alld Viclor H. Frankel</p> <p>---------~</p> <p>Acknowledgments _--..</p> <p>This book was made possible through the outstanding contributions of many individuals. The chapter authors' knowledge and understanding of the basic concepts of biomechanics and their wealth of experience have brought both breadth and depth to this work. Over the past 10 years. questions raised by students and residents have made this book a better teaching tool. The Third Edition could not have been done without the students who have shared their cornmen(s and really sCnItinizcd thc Second Edition. There arc too many names LO list here, but we thank each student who asked a question or made a suggestion during the course of his or her studies. Special thanks to the students who panicipated in several focus groups. whose input was invaluable in finalizing the contents and design of the text. Vve are honored and grateful for the contributions of everyone who has worked to prepare this new edition. 'vVe can honestly say that this third edition is written ror the sludent and by students and residents who leave the classroom with the knowledge to enhance our life and existence. A book of this size with its large number of figures, legends, and references cannot be produced without a strong editorial team. As project editor, Dawn Leger's continuous effort and perseverance and thoughtfulness shines through the entire book. She has contributed not just to the editing but also to logistics, and as a stylist, as an innovator, and a friend. Our editorial assistant, Angela Lis, is a physical thcrapisl and recent recipient of the MA degree in Ergonomics and Biomechanics from NYU. As a recent graduate, Angela was also a recent USCI' of the book, and she devoted several months to help finalize this edition. She created the flowcharts and scrutinized all the figures, patient cases, and caku-</p> <p>JUlian boxes. Angela look this book to her heart, and \ve arc all the bettcr for her passion and attention to detail. The illustrator: Kajsa Forssen. has now worked on all three editions of this text. Her never-failing grasp of hiomechanical illustrations, her simpli. city and exactness of figures, is always appreciated. In drawing all the figures and graphs, she considers how they would translate into a slide or into a computer-generated presentation. Kajsa Forssen is one of the top iIIustralOrs that we have ever worked wilh, and she has been an important member of the publication (cam. This book was also made when publication companies I11ergcd and merged again, and in the end we are deeply grateful to Ulila Lushnycky, who has with her team at Lippincott \Villiams &amp; Wilkins been responsible ror the production. She has worked with tremendous energy and posilive thinking, put the book together in record spced, and we fonvard our sincerest gratitude to her. \Ne are also thankful for a development grant provided by Lippincott Williams &amp; Wilkins to finance this effort. Our colleagues al the Occupational and Industrial Orthopaedic Cenler and the Department or Orthopaedics of the Hospital ror Joint Diseases Orthopaedic Institule functioned as critical reviewers and contributors to the chapters. Special thanks is extended to David Goldsheydcl" for assislance in reviewing lhe biomechanical calculation boxes. to Marco Campello as a contributor and reviewer, and to Shira Schccter-vVeiner for contributing to the spine chapteI: Much thanks to Dr. Mark Pitman 1'01' supplying vital x-rays ror the new edition. \,Ve are parlicularly grateful to DI: Markus Pielrek for contributing with the latcst on intraabdominal pressure. to Dr. Ali Sheikhzadeh ror reviewing chapters and contributing new</p> <p>references, to Dr. Tobias Lorenz for his work on the first section, and to all other staff at the Occupational and Industrial Orthopaedic Center who have been managing the center while we are absorbed wilh the book. \'\Fe arc most grateful to Drs. Bejjani, Lindh, Pitman, Peterson, and Stuchin for their COI1l1j bUlions to the second cdition which sen'cd as a framework for the updated third edition. The third edition of Basic Biomechallics orEiIe</p> <p>iHuscllloskeletal System was supported throughout its production by the Research and Development Foundation of the Hospital for Joint Diseases Orthopaedic Institute and the hospital administration, to whom we forward our sincere gratitude. To all who helped, we say' again, thank yOLi and TACK SA MYCKET.</p> <p>klargareta Nordin and Victor fl. Frankel</p> <p>Contributors</p> <p>Gunnar B. J. Andersson, M.D., Ph.D. Professor and Chairman Department of Orthopaedic Surgery Rush-Presbyterian-SI. Luke's Medical Center Chicago, IL Thomas P. Andriacchi, Ph.D. Biomechanical Engineering Division Stanford University Stanford, CA Sherry I. Backus, M.D., P.T.</p> <p>Craig J, Della Valle, M.D. NYU-HJD Department of Orthopaedic Surgery Hospital for Joint Diseases School of Medicine New York University New York, NY Victor H. Frankel, M.D., Ph.D., KNO</p> <p>President EmeritusHospital for Joint Diseases Orthopaedic Institute Professor of Orthopaedic Surgery New York University School of Medicine NevI York, NY Ross Todd Hockenbury, M.D. River City Ortl1opaedic Surgeons LouiSVille, KY Clark T. Hung, Ph.D. Assistant Professor Department of Mechanical Engineering and Center for Biomedical Engineering Columbia University New York, NY Debra E. Hurwitz. Ph.D. Assistant Professor Department of Orthopaedics RushPresbyterian-St. Luke's lvIedical Center Chicago, IL Laith M. Jazrawi. M.D. NYUHJD Department of Orthopaedic Surgery</p> <p>Senior Research Physical Therapist and Research AssociateMotion Analysis laboratory Hospital for Special Surgery New York, NY</p> <p>Ann E. Barr, Ph.D., P.T.</p> <p>Assistant ProfessorPhysical Therapy Department College of Allied Health Professionals Temple University Philadelpllla, PA Fadi Joseph Bejjani. M.D .. Ph.D. Director of Occupational Musculoskeletal Diseases Department University Rehabilitation Association Newark, NJ Maureen Gallagher Birdzell, Ph.D. Departmenl of Orthopaedic Surgery Hospital for Joint DiseasesiMI. Sinai NYU Health New York, NY Marco Campello, P.T., M.A. Associate Clinical Director Occupational and Industrial Orthopaedic Center Hospital for Joint DiseasesiMI. Sinai NYU Health New York. NY Dennis R. Carter. Ph.D.</p> <p>Hospital for Joint DiseasesSchool of Medicine New York University New York, NY Frederick J, Kummer, Ph.D.</p> <p>Associate Director, Musculoskeletal Research CenterHospital for Joint DiseasesiMt. Sinai NYU Health Research Professor, NYU-HJD Department of Orthopaedic Surgery Scl100l of Medicine New York University New York, NY</p> <p>ProfessorBiomechani...</p>